The Evolution of Psychological Treatment
For Mental Illness
As early as 3000 B.C., treatments were
developed to cure those deemed as mentally ill (Hergenhahn, 2014). Mental
illness is a condition that is said to exist when a person’s emotions,
thoughts, or behavior, deviates markedly from what is considered to be normal
at that certain time and place in history. Throughout history, there have been
multiple theories as to the cause of mental illness, however within the
multiple theories, the origin of each theory commonly falls into one of three
general models of explanation. The three general models of explanation are the
biological model, the psychological model, and the supernatural model. Biological
explanations of abnormal behavior constitute the medical model of mental
illness, which assumes that mental illness results from biological causes such
as brain damage, impaired neural transmissions, or biochemical abnormalities. Psychological
explanations are based on the assumptions that other events cause the abnormal
behavior seen. Supernatural explanations are based on the beliefs that mental
illness is caused by spiteful spiritual beings entering the body or by the will
of God. In any case, if any honest effort was made to treat mental illness, the
treatment used was determined largely by the beliefs concerning its cause.
Although having different explanations
for mental illness, each explanation had common elements for the treatment for
mental illness, which included the sufferer, the helper, and a ritual through
which help is given (Matarazzo, 1985). The biological approach to mental
illness assumes that all disease is caused by the malfunctioning of some aspect
of the body. Specific bodily abnormalities causing mental illness can be
inherited directly or through a predisposition inherited from your parents. The
biological explanation also includes any events that may interfere with the
normal functioning of the body. The psychological approach to mental illness
assumes psychological experiences and emotions are caused by the society around
the individual. The supernatural approach to mental illness assumes that most
ailments happen by the means of mysterious forces. Whether the illness was of a
physical or a mental nature, it was assumed that it was caused by supernatural
means. Biological, psychological, and supernatural explanations of mental
illness have almost always existed in one form or another, what has changed
through history is how one type of explanation has been emphasized over the other
Dating back to 3000 B.C., evidence has
suggested that ancient Egyptian cultures developed an understanding of physical
and mental diseases (Bierma, 2014). Egyptians used natural treatments such as
vapor baths and herbal therapies for those with physical or mental diseases.
Egyptian treatments also involved physical manipulations and primitive
surgeries because of their belief that physical and mental illnesses were
caused by bodily dysfunctions. Throughout this period, Egyptian doctors wrote
an ancient document known as the Ebers Papyrus, which described over seven
hundred solutions for the different ailments they treated (Bierma, 2014).
Although they were able to cure these ailments, Egyptians still believed unseen
spirits caused these bodily dysfunctions to occur.
Having close relationships with the
Egyptians, the early Greeks also believed that god inflicted mental illness
upon sinful people. However, Hippocrates (460-377 B.C.) was one of the first to liberate
medicine and psychiatry from their supernatural background. Hippocrates applied
the naturalistic outlook to the workings of the human body, relating one’s body
to being mad. Hippocrates argued that if there was an imbalance of bodily
fluids, then madness will occur. With this said, he believed it is the
condition of the brain which caused a person to be mentally normal or abnormal.
Hippocrates started a period of naturalistic and humane treatment of mentally
ill patients, which lasted through the time of Galen (129-199 A.D.).
Unfortunately, Hippocrates’ and
Galen’s ideas of humane treatment and a naturalistic approach to the mentally
ill did not last long. In 313 A.D., Emperor Constantine recognized Christianity
in the Roman Empire (Porter, 2002). Unlike the Greek philosophy, Christianity
denied the reasoning behind insanity was the essence of man and therefore recognized
the supernatural causes of insanity. The individuals who were seen as “insane”
were treated through spiritual methods including attending masses, exorcisms,
or a pilgrimage to a shrine.
Since the beginnings of human history,
magic, sorcery, and witchcraft have been practiced. In Christian Europe, prior
to about the middle of the 14th century, such activities were viewed
as remnants of paganism and were discouraged with relatively mild sanctions and
punishments (Hergenhahn, 2014). However, during this time period, witches and
witchcraft were taken for granted by almost everyone in Europe. Eventually, the
church became so concerned with witches and their evil deeds that a blanket,
institutionalized persecution of them was begun. This persecution lasted for
about three centuries, stretching from 1450 to 1750.
On December 9, 1484, Pope Innocent VIII
issued a papal bull that sanctioned the systematic persecution of witches
(Hergenhahn,, 2014). In his bull, the Pope gave Heinrich Kramer and James
Sprenger approval to act as inquisitors in northern Germany. Kramer and
Sprenger wrote Malleus Maleficarum in order to guide their work. The Malleus
attempts to prove the existence of devils and their hosts, witches. The book
also describes how agreements with the devil are made and consummated, the
various forms witchcraft can take, and how those suffering from witchcraft can
In general, all disorders, both physical
and mental, whose origins were not known were believed to be of supernatural origin,
or caused by witchcraft. These disorders included loss of sensory or motor
functions, sexual dysfunction, hallucinations, visions, mutism, apparitions,
drunkenness, depression, and sleepwalking. Treatments of those who had been
bewitched included exorcism, confession, prayer, repetition of holy scripture,
visits to holy shrines, as well as participation in church ceremonies (Porter,
2002). It was believed that sinful individuals were much more vulnerable to
witchcraft than were individuals without sin, and abnormal behavior was
generally taken as a sign of sinfulness. The Malleus also describes how witches
are to be forced to confess, tried, and punished. If interrogation and
punishment were unsuccessful in provoking a confession, more extreme measures
were taken such as the application of a red-hot iron or boiling water.
Eventually, most individuals confessed some sort of allegiance to Satan. There
has been estimates between 1450 and 1750, over 200,000 people in Europe were
accused of witchcraft and half of them were executed (Hergenhahn, 2014).
During the Renaissance, witch hunting was
widespread, and astrology, palmistry, and magic were extremely popular. At this
point, individuals with mental illnesses were generally assumed to be
bewitched, and they either roamed the streets or were locked up in “lunatic
asylums.” St. Mary of Bethelem Hospital was one such asylum. Established in
1247 as a priory, it was converted into a mental asylum in 1547 by the order of
King Henry VIII (Hergenhahn, 2014). This mental asylum became known as Bedlam
because of the Cockney pronunciation. Inmates were chained, beaten, fed only
enough to remain alive, subjected to bloodletting, and put on public display
for paying sight-seers.
Even during the 16th century,
when witch hunts and trails were popular, a few gutsy people argued that the
“bewitched” were not possessed by demons, spirits, or the devil. They argued
that the type of behavior the “bewitched” displayed was caused by emotional and
physical disorders. Such courageous individuals included Philippus Parcelsus (1493-1541),
Cornelius Agrippa (1486-1535), Johann Weyer (1515-1588). Their arguments lead
Louis XIV to abolish the death penalty for witches in 1682 (Porter, 2002).
mental illness increasingly came to be viewed as having natural rather than
supernatural causes, mental illness was still poorly misunderstood.
Bloodletting was still the most popular way of treating all ailments. Shock was
also a popular treatment used, which was introduced during Roman times.
Physicians would spin patients rapidly in a chair or throw several buckets of
cold water on chained patients (Hergenhahn, 2002).
During this time, Phillippe Pinel
(1745-1826) wrote multiple influential articles in which he argued for the
humane treatment of people with mental disorders. In 1793, Pinel was appointed
director of the Bicetre Asylum. Pinel proposed removing the chains from the
inmates. Although the authorities thought Pinel himself was insane, authorities
allowed Pinel to remove the chains in 1793 (Hergenhahn, 2014). Pinel gradually
removed chains from patients and observed their habits. Seeing the results as
successful, he removed the chains from more patients and improved rations of
food as well as stopping the practice of bloodletting and the chair. Pinel
argued effectively against any use of punishment or exorcism as treatment and was
responsible for many innovations in the treatment of the mentally ill. He also encouraged
patients to engage in physical rehabilitation and was the first to maintain
precise case histories and statistics on his patients.
Under his leadership, the number of
inmate deaths decreased dramatically, and the number of inmates cured and
released increased significantly. His success led him to be appointed as the
director of La Salpetriere, the largest asylum in Europe. With his success and
because of the Zeitgeist, people throughout Europe and the United States began
to argue for the humane treatment of the mentally disturbed Hergenhahan, 2014).
Along with Pinel, the talian physician, Vincenzo Chiarugi, argued for humane
treatment of the mentally disturbed:
It is a supreme and moral duty and
medical obligation to respect the insane individual as a person. It is
especially necessary for the person who treats the mental patient to gain his
confidence and trust. It is best, therefore, to be diplomatic and understanding
and try to lead the patient to the truth and to instill the way… The attitude
of doctors and nurses must be authoritative and impressive, but at the same
time pleasant and adapted to the impaired mind of the patient… Generally, it is
better to follow the patient’s inclinations and give him as much comforts as
advisable from a medical and practical standpoint. (Mora, 1959, p. 431)
During this time in the United States,
Dorothea Lynde Dix (1802-1887) began a 40-year campaign to improve the
conditions of the mentally ill. As a result of these individual’s efforts,
patients with mental illnesses began to receive better treatment. Alexander and
Selesnick speculate that there were three reasons for patients’ poor treatment,
even after it was no longer believed that they were possessed by demons. The
reasons were ignorance of the nature of mental illness, fear of those with
mental illness, and the widespread belief that mental illness was incurable.
Although Kraeplin, Witmer, and early
hypnotists dramatically improved the understanding and the treatment of mental
illness, people still wanted to know more. Emil Krapelin (1856-1926) was a
German psychiatrist who attempted to classify the multiple mental disorders. He
based his classifications on what caused them, how much they involved the brain
and the nervous system, their symptoms, and their treatment. Krapelin’s friend,
Alois Alzheimer (1864-1915), observed the general loss of memory, reasoning
ability, and comprehension which sometimes accompanies old age. Swiss
psychiatrist, Eugen Bleuler (1857-1939), found schizophrenia, which literally
means “a splitting of the personality.” The list of categories of mental
illness that many clinicians, psychoanalysts, and psychiatrists currently use
as a guide is found in The Diagnostic and Statistical Manual of Mental
Disorders, published by the American Psychiatric Association, is of direct
descent of Kraepelin’s work (Hergenhahn, 2014). Although Kraepelin’s
classifications clearly brought order to an otherwise chaotic mass of clinical
observations, people did not always fall neatly into the categories he created,
nor were the causes for their disorders always physical by nature.
Psychoactive drugs were also used to cure
different ailments. Such drugs as alcohol, opium, and hemp were used by ancient
Egyptian, Greek, Roman, Babylonian, Chinese, Hindu, and Arabic physicians.
Although most reports are concerned with medicinal properties of drugs, there
are also reports of using drugs to gain access to spiritual entities or
enlightenment. Kraepelin was among the first physicians to systematically study
the effects of drugs on various cognitive functions. Kraepelin found the
effects of alcohol, morphine, caffeine, and other drugs on such intellectual
tasks as comprehension, association, and memory.
Lightner Witmer (1867-1956) was an
experimental psychologist and professor at the University of Pennsylvania. In
1894, while teaching a special course offered to public school teachers, one of
the teachers described a problem one of her students was having. Witmer established
a theory that psychology should provide valuable information to the patient,
especially about the situation the patient was in. With this, Witmer developed
the profession and method of clinical psychology. A clinical psychologist
applies principles derived from psychological research to the diagnosis and
treatment of the disturbed individual. Although, Witmer was trained as an
experimental psychologist, not a clinician, he believed that clinicians should
be scientists who apply their knowledge to helping troubled individuals,
regardless their academic background.
Franz Anton Mesmer (1734-1815) developed
the theory of animal magnetism. Mesmer assumed that each person’s body contains
a magnetic force field. In healthy individuals, the force field was distributed
evenly throughout their body, but if the individual was unhealthy there would
be an uneven distribution of the force field. This uneven distribution caused
the physical symptoms presented by the individual. With the use of magnets, it
was possible to redistribute the force field and restore the patient’s health.
Although Mesmer’s theory of animal magnetism was rejected by most of those in
the medical field, the popularity of mesmerism (animal magnetism) continued for
about twenty years (Hergenhahn, 2012). “Mesmerists helped define the character
of psychology for their generation, showing how it was applicable to people’s lives
and that it was a ‘mental science’ based on obtaining ‘facts’ from demonstrable
‘experiments’ (Schmit, p.422).
Although Mesmer’s theory was rejected by
the medical world, many individuals still used and tried to modify his techniques.
Marquis de Puysegur (1751-1825) created a method known as artificial somnambulism
to treat his patients. During artificial somnambulism, Puysegur placed his
patients in a sleeplike trance, then instructed the patient to talk about a
certain topic, perform various motor activities, or dance even though there was
no music playing. When the patient “woke up,” they would have no recollection
of the events upon waking. Though not knowing what occurred while in the a
“trance,” patients were able to perform the act which was instructed without
any knowledge of why he or she was doing so.
Also convinced of the effectiveness of
hypnosis, Auguste Ambroise Liebeault (1823-1904) wanted to use hypnosis in his
practice. Liebeault could not find patients who willing to undergo hypnosis.
Eventually, he provided free treatment to any patient willing to undergo
hypnotism. Liebeault was so successful his practice was threatened with an
excess of nonpaying patients. He developed a school around his work called the
Regardless of the different beliefs of
causes or effective treatments of mental illness, every society has been known
to judge the mentally ill. Those with mental illnesses are given the stereotype
of being inferior, disgraceful, and weak (Rusch, 2005). Along with dealing with
their mental illness, the mentally ill have a very difficult time going about
their life because this stigma against them. As well as this, some of those
with mental illnesses accept the common prejudices of mental illness and turn
against themselves, eventually losing self-confidence.
The stigma against those with mental
illnesses often occurs because of the little knowledge known about the subject
and fear of those who are different (Rusch, 2005). With this being said, it is
important to keep an open-mind when dealing with the mentally ill. It is also important
to become knowledgeable about the subject, and to help those around you to
become knowledgeable, as well. By doing this, you can help those who are
mentally ill to accept their difference and comfort them as they go through the
tough times they are facing.
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